Health NW: Schizophrenia's effect on the mind

<center>Kathryn B. Brown, FNP</center>

Schizophrenia is a poorly understood mental illness. Historically, the bizarre behavior of people with schizophrenia caused them to be labeled "insane." Theories about the causes of insanity ranged from demonic possession to an imbalance of blood, phlegm and bile.

Now, we know that schizophrenia is probably caused by a number of factors. There can be an imbalance of brain chemicals called neurotransmitters. There may be abnormalities in the physical structure of the brain. It is definitely known that schizophrenia can be inherited. A person has a 1 percent chance of developing schizophrenia, but that goes up to 10 percent if he or she has a parent or sibling who has schizophrenia. If one identical twin has schizophrenia, the chance is 40 to 50 percent that the other twin will develop it also.

The symptoms of schizophrenia usually appear in the teen years, 20s or early 30s. The symptoms come on fairly suddenly, and are usually very frightening to affected people, as well to those around them.

There are some distinctive behaviors that are clues to the onset of this mental illness. People with schizophrenia:

• hear or see things that aren't there

• have a constant feeling of being watched

• speak or write in peculiar ways

• behave inappropriately or in a bizarre manner

• undergo personality changes

• withdraw from people and social situations

• have an angry, fearful or irrational response to loved ones

• cannot concentrate and have difficulty focusing their attention

• cannot express emotions normally

The term "psychotic" refers specifically to hallucinations (seeing, hearing or feeling things that aren't there) and delusions (believing things that aren't true, such as "someone is out to get me" or other paranoid beliefs). Most people with schizophrenia have these symptoms at some point in their illness, but not all people with psychotic symptoms have schizophrenia.

Anyone with these symptoms should be taken to see a health care provider right away. There are certain physical diseases, such as hyperthyroidism and lupus, which can temporarily cause schizophrenia-like symptoms. Also, substance abuse with methamphetamines, cocaine, marijuana or other drugs can cause these symptoms.

People with schizophrenia should be diagnosed and treated as soon as possible, since long-term results are better with early treatment. Without treatment, there may be some improvement in the person's symptoms after an acute psychotic episode, but another episode is likely to occur at some point.

Back in the 14th century, schizophrenia patients were usually put in insane asylums known for their ineffective and cruel treatments. By the 19th century, conditions in asylums were improving and patients were treated slightly more compassionately, but no effective medications existed.

In the 1930s, the first effective treatment found for schizophrenia was electro-convulsive therapy, called "shock treatments." This helped many patients and is sometimes still used today for those who do not respond to medications.

In the 1950s, drugs called "antipsychotics" were first used on people with schizophrenia. Now, newer antipsychotic drugs have been developed which have fewer side effects. However, finding the right drug or combination of drugs with few side effects for an individual is often a challenge.

This is a hopeful time for those with schizophrenia, as research is leading to new treatments and a deeper understanding of the causes of this disease. Also, public awareness of the problem has been helped by movies such as "A Beautiful Mind," the story of a brilliant man with the disease.

May is "Mental Health Month." All HealthNW columns will be dedicated to mental health topics.

Kathryn B. Brown is a family nurse practitioner with a master's degree in nursing from OHSU. Is there a health topic you would like to read about? Send your idea to

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